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General NPI Number Information
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NPI Number | 1326560327
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Entity Type | Individual
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Provider Name | ELISABETH FARMER EDDS LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 290 KRESS VENTURE RD
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City | CHINA GROVE
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State | NC
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Zip | 28023-8410
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Country | US
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Telephone | 704-754-8214
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Fax | 704-754-8214
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Provider Business Mailing Address
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Address Line | 1331 FORESTDALE DR
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City | SALISBURY
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State | NC
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Zip | 28144-2128
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Country | US
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Telephone | 704-640-7202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | LAT-3990
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License Number State | NC
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